PURPOSE: This retrospective study was conducted to evaluate the value of adminstration of IV gadopentetate dimeglumine for MR imaging of tuberculous spondylitis. MATERIALS AND METHODS: The authors reviewed MR images both with and without contrast enhancement of 22 patients with tuberculous spondylitis. Evaluation of signal characteristics, enhancement patterns, and difference of delineation between pre- and postcontrast enhancement was made on 4 compartments the vertebral body, intervertebral disc, paravertebral space, and extradural space. RESULTS: The spinal tuberculous lesions revealed relatively low or isosignal intensity on T1-weighted image and high signal intensity on T2-weighted image. The tuberculous lesions of vertebral body showed enhancement of mixed pattern, and rim enhancement pattern was predominant in the other 3 compartment, suggesting abscess. The contrast enhanced MR image showed better demarcation of the extents of tuberculous lesions comparing with noncontrast image, especially at the vertebral body and intervertebral disc. The nature of tuberculous involvement was better visualized at the extradural space and paravertebral space on postcontrast image. CONCLUSION: We conclude Gd-DTPA enhanced MR image can give informations for more detailed delineation, extents, and nature of involvement in the tuberculous spondylitis.
Abscess ; Gadolinium DTPA ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spondylitis*

OBJECTIVES: The aim of this study was to compare the 10-year probability of hip fracture and a major osteoporotic fracture using the FRAX algorithm between postmenopausal Korean women with and without type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: We used data from the Fourth Korea National Health and Nutrition Examination Survey 2008-2009. The measurements of anthropometric parameters and bone mass were obtained using dual energy X-ray absorptiometry (DXA) (Discovery-W, Hologic Inc., USA). Data was available for a total of 1,594 postmenopausal women (1,498 without T2DM and 96 with T2DM) aged 40 to 90 years old. The FRAX(R) 10-year probability was computed using the algorithm available online at http://www.shef.ac.uk/ FRAX (South Korea version). To compare the 10-year probability of osteoporotic fracture between the groups with and without adjustment for age and weight, a general linear model was used. RESULTS: Mean 10-year probabilities of fracture were similar between groups for major fractures [diabetic 9.0 (8.0, 10.0, 95% CI) versus non-diabetic 8.1 (7.8, 8.4, 95% CI), P=0.087] and hip fractures [diabetic 3.6 (2.8, 4.3, 95% CI) versus non-diabetic 2.9 (2.7, 3.1, 95% CI), P=0.099]. After adjustment for confounding factors (age and weight), there was also no significant difference between the diabetic and non-diabetic group [major osteoporotic fracture: 8.4 versus 8.1, P=0.563; hip fracture: 3.2 versus 2.9, P=0.320]. CONCLUSIONS: FRAX did not reflect higher major osteoporotic and hip fracture risk in Korean T2DM patients. T2DM might be considered for inclusion in future iterations of FRAX.
Absorptiometry, Photon ; Bone Density ; Diabetes Mellitus, Type 2 ; Female ; Hip ; Hip Fractures ; Humans ; Korea ; Linear Models ; Nutrition Surveys ; Osteoporotic Fractures

We report three patients with adrenal pheochromocytoma who were associated with type I neurofibromatosis. Two of them were asymptomatic, but one case involved hypertension. We reviewed medical records and adrenal imaging, and estimated the prevalence of adrenal pheochromocytoma among neurofibromatosis type I patients in one university hospital in Korea. A total of 658 patients were coded for neurofibromatosis type I (Q85.0 with International Classification of Diseases 10 version) with clinical impression, but only 371 were confirmed via 1997 National Institute of Health criteria. Adrenal images were generated in 203 patients, and 3 of them were diagnosed with pheochromocytoma. According to the results of this study, the estimated prevalence of adrenal pheochromocytoma in type I neurofibromatosis was 0.30-1.48%.
Humans ; Hypertension ; International Classification of Diseases ; Korea ; Medical Records ; Neurofibromatoses ; Neurofibromatosis 1 ; Pheochromocytoma ; Prevalence

The incidence of hypercalcemia in terminal cancer patients is rare but if it is not treated, the consequence is dismal. Hydration, diuretics, corticosteroids are not so effective for the treatment of hypercalcemia in this situation. Pamidronate (synthetic bisphosphonate analogue of pyrophosphonate) decreases the activity and the life span of the osteoclasts. It results in decrease in resorption of bone mineral, directly and indirectly. There are only a few reports on the usage of pamidronate in children. We experienced a case with hypercalcemia in patient with Wilms tumor who was treated with pamidronate. A 5-year-old male patient was admitted to Ajou University Hospital due huge abdominal mass. Abdominal CT revealed a huge mass originating from right kidney (size: 18 11 8 cm) with lung metastasis. The chemotherapy according to National Wilms Tumor Study (NWTS)-4 was started but there was no response after 4 months. Right nephrectomy with mass removal was done and the pathologic finding revealed diffuse anaplastic type. The serum calcium level increased to be 16.7 mg/dL at 7 days after operation which was not responsive to hydration and furosemide. Pamidronate was given at the dose of 1 mg/kg and the serum calcium decreased to 8.0 mg/dL 24 hours later. The pulmonary lesion progressed and the patient died 4 months after operation but the serum calcium level remained within normal range thereafter.
Adrenal Cortex Hormones ; Calcium ; Child ; Child, Preschool ; Diuretics ; Drug Therapy ; Furosemide ; Humans ; Hypercalcemia* ; Incidence ; Kidney ; Lung ; Male ; Neoplasm Metastasis ; Nephrectomy ; Osteoclasts ; Reference Values ; Tomography, X-Ray Computed ; Wilms Tumor*

Hajdu-Cheney syndrome (HCS) is a rare skeletal dysplasia that is characterized by acroosteolysis of the distal phalanges, distinctive craniofacial and skull changes, dental abnormalities and generalized osteoporosis. The clinical and radiologic characteristics are variable and these characteristics progress with age. This syndrome shows autosomal dominant inheritance with sporadic cases. The genetic defects or molecular pathogenesis of HCS are still unknown. We experienced a case of Hajdu-Cheney syndrome in a 20-year-old man who had generalized osteoporosis with multiple non-traumatic spine compression fractures. He had acroosteolysis of the hands and feet, wormian bones in the skull, facial dysmorphism (mid-facial flattening, micrognathia and bushy eyebrows), a high arched palate, malocclusion and short dental alveolar processes. HCS was diagnosed based on the clinical and radiologic evidence. For the differential diagnosis, we excluded the other possible causes of the acroosteolysis and wormian bones, including hyperparathyroidism, osteogenesis imperfecta, hypophosphatemia and mandibuloacral dysplasia. The specific treatment of HCS is unknown, but case reports with bisphosphonate treatment have been reported.
Acro-Osteolysis ; Alveolar Process ; Diagnosis, Differential ; Foot ; Fractures, Compression ; Hajdu-Cheney Syndrome ; Hand ; Humans ; Hyperparathyroidism ; Hypophosphatemia ; Malocclusion ; Osteogenesis Imperfecta ; Osteoporosis ; Palate ; Skull ; Spine ; Wills ; Young Adult

OBJECTIVES: It is important to consider the symptoms of diabetic neuropathy in determining a diagnostic approach. To evaluate diabetic neuropathy, an appropriate questionnaire for Korean diabetic patients is required. In 1994, Feldman et al. proposed the two-step diagnostic approach which included a questionnaire. To adapt a diagnostic approach and questionnaire for Korean diabetics, we initially diagnosed diabetic neuropathy by using Feldman's method and by assessing the efficiency of their method for Korean diabetics as a preliminary study. METHODS: We diagnosed diabetic neuropathy with Feldman's method in 99 NIDDM patients who visited Ajou university hospital from October 1, 1996 to April 30, 1997. The sensitivity and specificity of Feldman's 4 diagnostic procedures were ebaluated. To include the highly specific symptoms in the diagnostic approach, we applied a different scoring system(from 5 to 1) to the questionnaire accroding to specificity and then evaluated the sensitivity and specificity with this new system. If the sensitivity and specificity were 60% or more, the new scoring system was regarded as clinically useful. RESULTS: Using Feldman's method, the sensitivity of MNSIQ and MNSIC was 12.8% and the specificity was 88.3% and 98.3%, respectively. The sensitivity of MDNS and NCV was 100% and the specificity was 68.3% and 61.6%, respectively. The new scoring system consisted of 13 of 15 questions with sensitivity of 46.2% and specificity of 71.7%, omitting 2 questions due to possible relation to vascular symptoms. Among the 4 diagnostic procedures, the strongest correlation existed between MDNS and NCV. None of the procedures had a significant correlatiion with MNSIQ. MNSIC, which shares similar characteristics with MDNS, had significant correlation with MDNS and NCV, but its sensitivity was very low. CONCLUSON: MNSIQ and MNSIC were not useful as screening instruments in the diagnostic approach to diabetic neuropathy using Feldman's method. Thus, a new questionnaire composed of symptoms common in Korean diabetic patients should be designed, and MNSIC could be omitted from the diagnostic approach.
Diabetes Mellitus, Type 2 ; Diabetic Neuropathies* ; Diagnosis ; Humans ; Mass Screening ; Sensitivity and Specificity ; Surveys and Questionnaires

BACKGROUND: Leptin has been reported to be correlated with the amount of adipose tissue in humans. The plasma leptin concentrations were not different between diabetics and non-diabetics in Mexican-Americans; however, the leptin might stimulate or diminish insulin secretion and induce insulin resistance. Then, it can be postulated that leptin may one of the key factors in the development of insulin resistance. Therefore we were to note any differences in FPL (fasting plasma leptin levels) between diabetics and normal subjects, and to investigate variables such as PBF (percentage body fat), BMI (body mass index), FPI (fasting plasma insulin) to determine their effects on the variation of FPL. We also were to investigate whether FPL influenced the GUR (glucose utilization rate). METHODS: The subjects were 116 type 2 diabetics and 45 normal subjects in Korean. PBF, BMI, WHR (waist hip ratio) were measured. Fasting plasma insulin and leptin levels were measured by radioimmunoassay. Euglycemic and/or hyperglycemic clamp tests were performed in 19 diabetics and 16 normal subjects. RESULTS: 1. There was no difference in FPL between diabetics and normal subjects. 2. A significant difference was found in FPL between female and male subjects. 3. Gender and body composition such as PBF, BMI contributed plasma leptin levels. 4. FPL was associated with GUR (Insulin resiatance) only in male subjects. 5. During 2h clamp tests, the acute increments of insulin or glucose did not change the leptin levels. CONCLUSION: These data suggested that there was no difference in FPL between diabetics and normal subjects, whereas gender, body composition such as PBF, BMI contributed leptin levels.
Adipose Tissue ; Body Composition ; Fasting ; Female ; Glucose ; Hip ; Humans ; Insulin Resistance* ; Insulin* ; Leptin* ; Male ; Obesity* ; Plasma* ; Radioimmunoassay

PURPOSE: To document the radiologic characteristics of Korean Gaucher disease. MATERIALS AND METHODS: Fifteen bone marrow biopsy and laboratory data confirmed Gaucher disease patients (age 1 -21, mean 10.9 yr) wereundertaken plain X ray and MRI. Number of type I were 10, type II, 2, type III, 3. Seven were splenectomized oninitial evaluation or during follow up. Five enzyme treated patient were undertaken follow-up MR examinationduring 6 -40 month with 6 month interval. Conventional T1 and T2WI of spine and femur was performed and FMPSPGR inand out of phase image was also done. Volume of liver and spleen were measured, and bone marrow infiltration andpresence of infarction were scored according to 6 scale scoring system. Clinical data were also reviewed andcorrelated with the MR findings. RESULTS: Marrow infiltration was noted in 71.4% of all patients in MRI, while itwas in 45.7% with plain radiography. Type I group showed marrow infiltration in all but one cases, which wasparallel with ages, SGPT, and presence of osteopenia, reversely correlated with spleen size. Severe bonecomplications (infarction or fracture) were noted in 7 of 10 type I group, and 6 patients showed severe growthretardation (below 3rd percentile). Follow up MR examination of 5 patient showed decrease in liver and spleen sizefirst without bone change until 6 months. There showed bone regeneration in 2 patient 1 year after, and increasedfat signal in one patient 3.5 years after. In and out of phase images couldn't help in quantifying fatcomposition in bone marrow. CONCLUSION: Korean Gaucher patients revealed as more severe skeletal complicationsthan others reported from Western groups. MR examination is a effective modality to evaluate and monitor ofGaucher patients.
Alanine Transaminase ; Biopsy ; Bone Diseases, Metabolic ; Bone Marrow ; Bone Regeneration ; Femur ; Follow-Up Studies ; Gaucher Disease* ; Humans ; Infarction ; Liver ; Magnetic Resonance Imaging ; Metabolism ; Radiography ; Spine ; Spleen

No abstract available.
Glucose Transport Proteins, Facilitative* ; Glucose* ; Humans ; Insulin* ; Metabolome*

BACKGROUND: Outpatient surgery has recently grown at a substantial rate. The development and use of short acting anesthetic and analgesic agents have played a major role in the growth of outpatient surgery. This study was designed to evaluate the intraoperative hemodynamic responses and recovery characteristics, using propofol or isoflurane to maintain the anesthesia. METHODS: A total number of 30, ASA physical status I-II patients scheduled for outpatient surgery, all of whom were to undergo excision of breast mass. The patients were randomly allocated to receive either total intravenous anesthesia with propofol, or inhalation anesthesia with isoflurane after induction of anesthesia with propofol. All patients were ventilated via a laryngeal mask airway (LMA) using a mixture of oxygen and air so that the FiO2 would be 0.4. RESULTS: There were no significant differences in hemodynamic changes during anesthesia in recovery time, or in complications between the two groups. CONCLUSIONS: We conclude that both methods provide reasonably rapid and reliable recovery from anesthesia and are equally acceptable to the patients.
Ambulatory Surgical Procedures* ; Analgesics ; Anesthesia* ; Anesthesia, Inhalation ; Anesthesia, Intravenous ; Breast ; Hemodynamics ; Humans ; Isoflurane ; Laryngeal Masks ; Outpatients* ; Oxygen ; Propofol*